Basic Information
Provider Information
NPI: 1043750995
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STRAWHACKER
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MDT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 813 FLORIDA ST SW
Address2:  
City: LONSDALE
State: MN
PostalCode: 550468601
CountryCode: US
TelephoneNumber: 9524579313
FaxNumber:  
Practice Location
Address1: 309 HOLLY LN
Address2:  
City: MANKATO
State: MN
PostalCode: 560015422
CountryCode: US
TelephoneNumber: 5073882120
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/26/2017
LastUpdateDate: 02/26/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
125J00000XDT81MNY Dental ProvidersDental Therapist 

No ID Information.


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